Clinical Analysis Of16Cases With Congential Tracheobronchial Stenosis In Children

Objective:To summarize clinical characteristics of Congenital tracheo-bronchial stenosis (CTS) and analyze the experience in diagnosis and therapy of CTS.Methods:16cases with CTS from January2005to March2012were retrospectively analyzed by clinical features, results of Chest CT bronchoscopy, diagnosis and therapy in our study.Results:(1) There were11male and5female cases in the group, the range of age of their onset was1day-old to3.5year-old.(2) Of the16cases,13cases (81.2%) presented with recurrent or persistent cough,12cases (75.0%) presented with inspiratory and expiratory wheezing,8cases (50.0%) presented with tachypnea,6cases (37.5%) presented with dyspnea,5cases (31.3%) presented with laryngeal stridor,4cases (25.0%) presented with hoarseness,2cases(12.5%)presented with asphyxia,2cases(12.5%)presented with difficulty in tracheal intubation,1case (6.3%) presented with apnea and1case (6.3%) presented with difficulty in withdrawing from mechanical ventilation.10cases (62.5%) could found inspiratory and expiratory rales,6cases (40.0%) presented with cyanosis and inspiration retraction of the chest wall, and3cases (18.8%) with congenital heart disease could hear heart murmurs.(3)10cases had been misdiagnosed, which included congenital heart disease (3cases) bronchial foreign body (2cases), asthma (2cases), recurrent respiratory infection (2cases) and asthmatic pneumonia (1case).(4)5cases only underwent the Chest CT with3D reconstruction of trachea,2cases underwent the bronchoscopy singly, and9cases underwent both examinations mentioned above. There was consistency between the Chest CT with3D reconstruction of trachea and the bronchoscopy for diagnosing CTS.(5) Other congenital malformation or abnormities were found in8cases (50.0%) including cardiac malformation (4cases),other respiratory anomalies (4cases) and congenital hypertrophic pyloric stenosis (2cases).(6) All the cases had been only treated with conservative therapy, in which2cases with severe stenosis died from pulmonary infection and1case with severe stenosis gave up the treatment finally.(7) Complete disappearcance of respiratory symptoms were found in4ones of the13cases with mild or moderated stenosis and another9cases had improved significantly. One case with severe stenosis of left principal bronchus and congenital heart disease still suffered from recurrent cough, stridor and recurrent respiratory infection after having done the heart surgery.Conclusions:(1) The children with CTS presented few specific clinical manifestation, which leaded to misdiagnosis easily. Diagnosis of CTS should be considered in the children who presented recurrent cough, stridor, or dyspnea during the infantile period.(2) Other congenital malformation or abnormities were common in the patients with CTS, in which the most common one was cardiac anomalies.(3)Both the Chest CT with3D reconstruction of trachea and the bronchoscopy played an important role in the diagnosis of CTS and they could make up respective disadvantages so as to differentiate the abnormalities between the inner and outer of the airway.(4) With growing up, the respiratory symptoms of the patients with mild or moderate stenosis could relieve, even completely disappeared. However the patients with severe stenosis presented poor prognosis when having treated with conservative therapy only, which indicated that a surgery was necessary.